Nurse Education in Practice 15 (2015) 561e566

Contents lists available at ScienceDirect

Nurse Education in Practice

journal homepage: www.elsevier.com/nepr

The effect of clinical nursing instructors on student self-efficacy

Melodie Rowbotham*, Rachel M. Owen 1
Southern Illinois University of Edwardsville, 3331 Alumni Hall School of Nursing Southern Illinois University Edwardsville, Edwardsville, IL 62026, USA

a r t i c l e i n f o a b s t r a c t

Article history: Clinical practicum experiences for nursing students provides the students an opportunity to apply
Received 15 September 2014 concepts learned in class, practice skills learned in lab, and interact with patients, families, and other
Received in revised form nurses. Although students look forward to these experiences, they often feel intimated and anxious
16 February 2015
about them. Clinical instructors play an important role in this experience and can either help or hinder
Accepted 25 September 2015
student learning and self-efficacy. Using Bandura's Social Learning Theory as foundation, this descriptive
study examined the relationship between perceived instructor effectiveness and student self-efficacy.
Keywords:
Data were collected from a BSN school of nursing at a Midwestern USA comprehensive masters uni-
Clinical teaching
Student self-efficacy
versity. The instruments used were the Nursing Clinical Teacher Effectiveness Inventory (NCTEI) and the
Effective teaching student self-efficacy (SSE) questionnaire. Participants (n ¼ 236) were from a traditional nursing program
Undergraduate students with 86% female and 14% male. Data was analyzed using Pearson's correlation and MANCOVA. Results
indicated: Out of the five areas of attributes, one area showed significant (p < .01) difference between the
lower and higher self-efficacy groups and with specific teacher behaviors within the Evaluation category.
Students with high self-efficacy reported faculty who suggested ways to improve, identified strengths
and weaknesses, observed frequently, communicated expectations, gives positive reinforcement ad
corrects without belittling. This can help faculty develop behaviors that increases student learning and
student self-efficacy.
Published by Elsevier Ltd.

Introduction the conscious awareness of one's ability to be effective and to

Clinical practicum experiences provides nursing students an
opportunity to apply concepts learned in class, practice skills
learned in lab, and interact with patients, families, and other
nurses. Although students look forward to these experiences, they
often feel intimated and anxious about them. During clinical
practicum, stressful situations may arise, which can increase the
students' anxiety level and may impede the students' learning
ability (Elliot, 2002; Melincavge, 2011; Papastavrou et al., 2010;
Sharif and Masoumi, 2005). Clinical instructors play an important
role in this experience and can either help or hinder student
learning and self-efficacy.
Self-efficacy is multidimensional and influences the cognitive
and affective processes of students. Self is the identity of a person,
while efficacy is defined as the power to produce an effect. It is also
control actions (Zulkosky, 2009). Self-efficacy is the perceived be-
liefs of one's capability to produce a level of performance that ex-
ercises the influence over events affecting their lives (Bandura,
1994). Self-efficacy is the underlying principle of nursing educa-
tion. However, there is limited research in the actual clinical setting
and in regards to the relationship of the clinical faculty with stu-
dent self-efficacy.
Clinical teaching in the United States typically consists of a
nursing faculty accompanying six to ten students to a clinical site.
The clinical site may be in the hospital, community or other facility
where nurses may practice. The student usually attend clinical for
fundamental nursing, medical surgical nursing, maternal newborn
nursing, pediatrics, mental health and community. A clinical
instructor or faculty member is one who teaches or is responsible
for students at these sites.

Theoretical framework

* Corresponding author. Tel.: þ1 618 650 5319.

E-mail addresses: mrowbot@siue.edu (M. Rowbotham), rowen@siue.edu
Bandura's Social Learning Theory was the theoretical framework
(R.M. Owen). for this study. A person's self-efficacy helps determine how people
1
Tel.: þ1 618 650 5319. feel, think, motivate and behave (Bandura, 1994). Self-efficacy is a

http://dx.doi.org/10.1016/j.nepr.2015.09.008
1471-5953/Published by Elsevier Ltd.
562 M. Rowbotham, R.M. Owen / Nurse Education in Practice 15 (2015) 561e566
central concept in social cognitive theory and is thought to facilitate
actions and behaviors such as decision-making (Lauder et al.,
2008). Learning can be affected by a student's perception of suc-
cess or failure.
Self-efficacy influences a person's cognitive ability or the
thinking process that is involved in obtaining, organizing, and using
information (Bandura, 1994). A stronger perceived self-efficacy
leads a person to set higher goals and increases commitment to
obtaining that goal. In order for the student to succeed in the
clinical setting, they need to be motivated. A person's self-efficacy
contributes to their motivation in several ways: determines the
goals they set; the effort they expend; how long they persevere;
and their resilience to failures (Bandura, 1994). Motivation is
essential for student success. In order for students' to keep moti-
vated, they need to be able to cope with the stresses of clinical
practicum.
In the clinical setting, students often encounter situations that
can create stress and anxiety. Self-efficacy can shape the course of
people's lives by impacting the environment and the activities they
choose (Bandura, 1994). Those students with a higher sense of self-
efficacy are more likely to choose challenging activities that would
enhance their learning and increase their skills to be a nurse.
Clinical faculty need to understand how self-efficacy can influence
a student's performance, and how the clinical instructor in turn
influences the student's self-efficacy. How a clinical instructor in-
teracts and responds to students can either increase or decrease a
students' belief in themselves to be successful. The purpose of this
study was to examine the relationship between clinical instructors'
behavior that help and hinder student self-efficacy within the
clinical practicum.
Literature review
A literature review was conducted through Cumulative Index of
Nursing and Allied Health Literature (CINHAL) electronic database.
Key search words included: self-efficacy, clinical, undergraduate
student and teachers. Only studies with the focus of clinical
teaching were included for this study. In the past decade, numerous
researchers have studied the perception students have of their
clinical faculty. Identifying what students believe to be effective or
ineffective instructors and what helps increase or impede learning
is an essential component of understanding the role the clinical
instructor plays in learning and on student self-efficacy. There is a
lack of current literature addressing the effectiveness of the clinical
instructor, student self-efficacy, and the interaction of these
concepts.
Ineffective clinical instructor
Certain traits of the clinical instructor may impede learning in
the clinical setting. The behavior the students disliked the most was
personality characteristics of the clinical instructor, followed by
interpersonal relationships, and then teaching abilities. The stu-
dents' concluded that it was the instructors' attitude toward the
students that was ineffective; more than the teachers' professional
abilities (Tang et al., 2005). Prior work also revealed ineffective
instructor was one who is not a good role model, is unable to direct
them to literature to help them answer their questions, and failure
to identify students' strengthens and weaknesses (Kotzabassaki
et al., 1997; Mogan and Knox, 1987; Nehring, 1990). Researchers
also found instructors who belittled, does not provide constructive
feedback, or criticizes students in front of others were not
perceived as effective.
Certain instructor characteristics heighten the students' anxiety
level during clinical, such as, an impolite manner toward students,
difficult to communicate with, and treating students as irrespon-
sible adults (Cook, 2005). These personality traits and attitudes
may deter students' learning and may also influence student's self-
efficacy.
Effective clinical instructor
The approach the instructor takes while in the clinical setting
can also improve learning and decrease anxiety. The instructor who
is more encouraging, inviting, shows respect, expresses pleasure in
helping students, selects appropriate patient assignments, acts
friendly and is trustful of students will lower students' anxiety
levels (Cook, 2005). Along with the approach instructors take there
are five areas of attributes that can influence student learning.
Students identified the most common attribute as being helpful
to their learning was in the category of interpersonal relationship
(Tang et al., 2005; Elcigil and Yildirim, 2008; Parsh, 2010; Nahas
et al., 1999). Clinical instructors should be empathic, motivational,
understanding, available, inviting, respectful, and increase student
confidence (Cook, 2005; Elcigil and Yildirium, 2008; Gignac-Caille
and Oermann, 2001; Kelly, 2007; Parsh, 2010; Wills, 1997). These
traits help the instructors to be more approachable and the stu-
dents are more likely to interact positively with them.
The second clinical instructor attribute to help improve learning
in the clinical setting is evaluation. Evaluation is crucial to the
student. The instructor needs to realize that providing positive
feedback can inspire students to learn more, work together with
other students, and develop critical thinking. When responding to
questions from the students, the instructor needs to have direct and
energetic responses (Elcigil and Yildirium, 2008; Gignac-Caille and
Oermann, 2001; Lee et al., 2002; Parsh, 2010). Evaluation has also
been identified as important in the development of student self-
respect and self-confidence (Gignac-Caille and Oermann, 2001).
Of the five areas of behaviors, Kotzabassaki et al. (1997) reported
that evaluation was the least important behavior, but Viverais-
Dresler and Kutschke (2000) found that nursing students thought
it was the most important and that fairness and constructive
feedback enhanced learning.
Another characteristic for an effective clinical instructor is the
instructors' ability to teach. The instructors needs to guide the
students to either the correct answer or where to find the answer
(Elcigil and Yildirium, 2008; Parsh, 2010). The instructors also need
to demonstrate new skills to the students and be able to coach
students through the skill and encourage practice (Elcigil and
Yildirium, 2008; Gignac-Caille and Oermann, 2001; Kelly, 2007;
Kotzabassaki et al., 1997; Parsh, 2010).
The fourth clinical instructor attribute is competence. The
instructor should be knowledgeable about the area of clinical
rotation they are in, as well as being a role model for the students to
look up to (Elcigil and Yildirium, 2008; Gignac-Caille and Oermann,
2001; Kelly, 2007; Lee et al., 2002; Nahas et al., 1999). Students
need to be able to trust the instructor and know that the instructor
is not giving them wrong information. Behavior is often learned
through observation and modeling (Zulkosky, 2009). Modeling
good skills, techniques and appropriate behavior by the clinical
instructor is part of student learning.
The final clinical instructor attribute is personality. The
instructor should be able to communicate well with students. The
instructor should always have a smile, be positive, and always
defend the student in time of a crisis (Kotzabassaki et al., 1997;
Elcigil and Yildirium, 2008). The instructor should also display a
love for teaching and enjoy sharing their experiences/mistakes they
make with the students (Parsh, 2010). The interaction of the
instructor and the enthusiasm shown for learning and the profes-
sion encourages students to feel the same.
 M. Rowbotham, R.M. Owen / Nurse Education in Practice 15 (2015) 561e566 563

Student self-efficacy in the clinical setting Sample

Nursing education research has examined self-efficacy in rela- Students of a school of nursing at a Midwestern comprehensive
tionship to the utilization of simulation (Burke and Mancuso, 2012; university were asked to complete the NCTEI and SSE instrument.
Cardoza and Hood, 2012; Leigh, 2008; Pike and O'Donnell, 2010; The sample size was 236 juniors and seniors who had completed
Sinclair and Ferguson, 2009; Thomas and Mackey, 2012; Shinnick clinical courses. A total of eight courses were attended which rep-
et al., 2011) and to increase confidence in the performance of resented 30 clinical groups. No information was collected on the
nursing skills and in clinical reasoning skills (Bambini et al., 2009; instructors as the study focused on the perception of the students
Kuiper et al., 2009). Self-efficacy has also been studied in connec- and the researchers wanted to make sure the students felt free to
tion with mathematical achievement, and successful drug dosage give open and honest feedback. The majority of the students were
calculations. There has been little research looking at the role the Caucasian, with a mean age of 22 and consisted of about 48% ju-
clinical instructor has on student self-efficacy. niors and 51% seniors (Table 1).
Clinical practicum is a stressful time for any student, which may
hinder the learning experience and decrease student self-efficacy. Instruments
Unfortunately, nursing school does not always support student
learning (Livsery, 2009), which makes learning the information for The Nursing Clinical Teacher Effectiveness Inventory (NCTEI)
clinical practicum even harder. Not only that, students need to (Knox and Mogan, 1985) survey tool includes 47 questions within
know that memorizing information from pervious class is not five categories (teaching ability, nursing competence, evaluation,
sufficient enough to apply their knowledge during clinical prac- interpersonal relationship, and personality) using a 7- point Likert-
ticum (Lee, 2007). The instructor plays a major role in student self- type scale that evaluates the student's perceptions of effective
efficacy in clinical practicum. Research has shown that if instructors clinical instructors. Knox and Morgan (1985) reported reliability
model their caring behavior with students, this will impact the coefficients for each of the five categories with Cronbach alpha's
clinical experience and increase the student self-efficacy (Livsery, ranging from .79 to .89. Test and retest reliability was determined
2009). If a student experiences a negative outcome during clin- with p values ranging from .5 to .9 indicating acceptable reliability.
ical, the instructor should investigate the reason and assess the Content validity was determined by the examination of the in-
impact it made upon the student. According to Livsery (2009), all strument by faculty, students, and review of literature (Knox and
students should emerge from clinical practicum with greater self- Morgan, 1985).
confidence and self-efficacy which assesses the impact the The student self-efficacy (SSE) survey tool was also completed by
outcome had on the student. By understanding Bandura's social the students. The SSE, created by the author, is a 10-item ques-
learning theory and the clinical instructors' characteristics that help tionnaire on a 4-point Likert-type scale that evaluates student self-
or hinder student self-efficacy, instructors can develop or change efficacy. The Student Self-Efficacy Scale (SSE) was developed by
behaviors to increase student learning and increase student self- Rowbotham and Schmitz (2013). The four areas addressed by the
efficacy. Students with higher self-efficacy are more likely to scale are: a) academic performance, b) skill and knowledge devel-
strive for excellence within the clinical practicum. opment, c) social interaction with faculty, and d) coping with aca-
demic stress. This ten-item scale uses a four-point response format
Research design so there is no middle ground. Therefore, scores also ranged from 10
to 40 with higher scores representing higher student self-efficacy.
In this descriptive study, the relationship between instructor The initial Cronbach Alpha of .84 (n ¼ 64) and in this study it was
behavior in the clinical setting and student self-efficacy was .81 (n ¼ 236).
examined. The research question was: What clinical instructor A 5- item demographic questionnaire developed by the authors
characteristics or behaviors in the clinical setting influences stu- was used to obtain the demographic variables of the traditional
dent self-efficacy? This study was conducted using two in- nursing students.
struments: Nursing Clinical Teacher Effectiveness Inventory
(NCTEI), student self-efficacy (SSE), and a demographic page. Fac- Data analysis
ulty were approached and asked for permission to attend class and
collect data. Students were asked to complete the NCTEI by Data were analyzed using SPSS and descriptive and multivariate
reflecting on current clinical instructors as well as completing the statistics were used to analyze the relationship between perceived
SSE.
After obtaining consent from the Institutional Review Board
Table 1
(IRB), researchers asked permission to attend junior and senior
Demographics.
clinical theory courses and distribute the NCTEI and SSE ques-
tionnaires. The questionnaires were anonymously answered and no Variable N Value
identifying information was included on the instrument or on the Age 236 Mean ¼ 22
demographics. The research project was explained to the students Gender
and verbal consent was given. Students were also told they could Female 204 86%
Male 32 14%
return a blank survey if they did not wish to participate. The pri- Ethnic group
mary investigator was not the clinical faculty for any of the clinical Caucasian 203 86%
groups surveyed. She was the theory course faculty for one of the African American 17 7%
courses but the co-author collected those data. The co-author was a Asian 5 5%
Hispanic 2 1%
senior student in the program at the time but PI collected data from
Other 6 3%
the course she was in. Data was collected toward the end of the Level in program
clinical course so the students had time to observe and develop a Junior 1 semester 88 37%
relationship with the clinical faculty. Instructions were given to Junior 2 semester 27 11%
reflect on the clinical instructor they currently have. The data were Senior 1 semester 93 39%
Senior 2 semester 28 12%
entered and analyzed using IBM SPSS Statistics 21.0 (2013).
564 M. Rowbotham, R.M. Owen / Nurse Education in Practice 15 (2015) 561e566
clinical instructor behavior and student self-efficacy. Internal con-
sistency reliabilities (Cronbach Alpha) were used to determine in-
strument reliability and were found to be .99 for the NCETI and .808
for the SSE. Scores were summed within all items for each category
of the NCETI with higher scores indicating more positive teacher
characteristics. The SSE mean score was used in the data analysis
with the higher the mean implying higher students' perception of
their self-efficacy. Pearson's correlations between the SSE mean
and the NCETI subgroups identified significant correlations for
Teaching Ability (r ¼ .159, p ¼ .015), Nursing Competence (r ¼ .145,
p ¼ .026), Evaluation (r ¼ .166, p ¼ .011), and Interpersonal Re-
lationships (r ¼ .170, p ¼ .009). Therefore, a MANCOVA was used to
address the research question and identify specific teacher behav-
iors that influence the students' self-efficacy. Preliminary analyses
were performed to ensure no violations of normality, linearity or
homoscedasticity and no serious violations were noted.
To determine possible differences, students were grouped by
converting the student self-efficacy total scores to z-scores and two
groups identified to create a new grouping variable called SSE group
(lower and higher). These groups were then used to study the
relationship with five categories of teacher behaviors from the
NCETI using MANCOVA. Because of possible differences in student
self-efficacy related to experience, a co-variant was created for the
semester (Junior 1,2 and Senior 1,2) the student was enrolled in.
Specific differences in the teacher behaviors and student self-
efficacy were identified by independent t tests. The specific be-
haviors (questions on the survey) in each of the significant cate-
gories and the student self-efficacy groups were used.
Results
A one-way between groups multi-covariate analysis was per-
formed to investigate differences in student self-efficacy (SSE)
related to teacher behaviors. Five dependent variables were used:
Teaching Ability, Nursing Competence, Evaluation, Interpersonal Re-
lations, and Personality. The independent variable was SSE group
(lower or higher). There was a statistically significant difference
between lower and higher SSE groups on the combined dependent
variables, F (5, 225) ¼ 2.996, p ¼ .012; Wilks' Lambda ¼ .938. When
the results for the dependent variables were considered separately
(Table 2), one of the five dependent variables reached statistical
significance, using an Bonferroni adjustment of the alpha to .01;
Evaluation, F (1,229) ¼ 7.47, p ¼ .007, partial eta squared ¼ .03. An
inspection of the mean scores indicated students with a higher self-
efficacy reported slightly higher for the Evaluation teacher charac-
teristics (M ¼ 6.1, SD ¼ 1.22) than the lower self-efficacy students
(M ¼ 5.61, SD ¼ 1.42). Indicating that for this group of students
Evaluation they received from their clinical faculty increased their
self-efficacy.
Further analysis of the relationship between evaluation behav-
iors of the clinical teachers and student self-efficacy, an additional
MANCOVA were performed with the eight behaviors in the Evalu-
ation category. There was no statistically significant difference be-
tween the SSE groups on the combined dependent variables, F (8,
Table 2
Tests of between-subjects effects.
Dependent variable
Student self efficacy Evaluation
Group Nursing competence
Interpersonal relations
Teaching ability
Personality
*p < .05 ** Bonferroni adjustment p < .01.
222) ¼ 1.56, p ¼ .139; Wilks' Lambda ¼ .947; partial eta
squared ¼ .05. When results for the dependent variables were
considered separately, there were four of the eight behaviors to
reach statistical significance, using an alpha of .01 to reduce the risk
for a Type 1 error. The clinical teacher who suggests ways to
improve (p ¼ .003), identifies strengths and weaknesses of student
(p ¼ .012), observes frequently (p ¼ .010), communicates expec-
tations (p ¼ .024), gives positive reinforcement (p ¼ .018) and
corrects without belittling (p ¼ .011) had students who reported
higher self-efficacy (Table 3). These behaviors were helpful in
increasing the student self-efficacy for this group of students.
Discussion
The findings from analysis of the Student Self-Efficacy Scale and
Nursing Clinical Teacher Effectiveness Inventory (NCTEI) indicated
that for this group of students one of the five categories, Evaluation,
was statistically significant in relationship to higher student self-
efficacy. However, this difference had a small effect size. The effect
size shows the strength of the relationship between variables. Polit
and Beck (2008) states that if there is a reason to believe that there
variables are strongly interrelated, then a small effect is sufficient.
Student perception of self-efficacy is strongly related to how they
feel they are meeting their goals and their ability to meet them.
Bandura (1994) suggests the feedback a person receives influences
their belief that they can be successful. Clinical faculty have a
pivotal role in this belief and can help students meet their goals or if
they need to motivate themselves and set other realistic goals.
Evaluation is crucial to the learning process, it helps the student
grow and mature as an adult, and molds the students into great
nurses. The findings of this study concurred with the findings in the
literature (Elcigil and Yildirium, 2008; Gignac-Caille and Oermann,
2001; Lee et al., 2002; Parsh, 2010; and Viverais-Dresler and
Kutschke, 2000). Lee et al. (2002) suggests students give more
importance to evaluation than do instructors. Providing construc-
tive feedback and being fair in the evaluation process have also
been identified as important skills for instructions to development
(Naha et al., 1999; Parsh, 2010). A critical result of self-efficacy is
motivation to continue when faced with challenges. The higher the
self-efficacy the more motivated a person can be (Bandura, 1994).
Clinical instructors help motivate students by providing effective
feedback. Growth within the students can only be done by doing an
evaluation of what the student has learned in the clinical prac-
ticum, which plays an important role in the future of that nurse
(Wills, 1997). Evaluation is crucial for the learning process and
helps the student to grow and mature as they learn to become a
registered nurse.
According to the literature discussed earlier, the other areas:
teaching ability, nursing competence, interpersonal relationships and
teacher personality all play a part in effective clinical teaching. For
this group of students those behaviors did not increase their self-
efficacy. Although, teaching ability, nursing competence, and inter-
personal relationships did not reach statistical significance with a p
value of <.01, they did reach significance at a p value of <.05. This
F P Partial eta squared
7.47 .007** .03
4.99 .026* .02
4.94 .027* .02
4.49 .035* .02
1.65 .201 .01
 M. Rowbotham, R.M. Owen / Nurse Education in Practice 15 (2015) 561e566
Table 3
Tests if between-subjects effects and estimated marginal means.
Evaluation F p
Identifies strengths and weakness 7.15 .012*
Lower self-efficacy (n ¼ 106)
Higher self-efficacy (n ¼ 128)
Observes frequently 7.58 .010*
Lower self-efficacy
Higher self-efficacy
Communicates expectations 7.12 .024*
Lower self-efficacy
Higher self-efficacy
Corrects without belittling 6.98 .011*
Lower self-efficacy
Higher self-efficacy
*p < .01.
indicates that with a larger sample size these behaviors may show
statistical significance. Further research is indicated. The only area
of behaviors that did not reach statistical significance was teacher
personality. Behaviors in this area includes enthusiasm, self-
confidence, open-minded, humor and organized. Clinical faculty
personality for this group of students was not significant at either
level. Indicating the students did not perceive these behaviors
influencing their self-efficacy. While these behaviors were not
statistically significant they continue to play a part in the devel-
opment of nursing students and have been found in the behaviors
of effective instructors.
Clinical practicums are essential and a very important part of
nursing education and provides opportunities for students to apply
what they are learning in theory courses, practice skills, and
enhance their clinical judgment. These findings can help faculty be
aware of their teaching behaviors that can help clinical nursing
students be successful. Helping faculty development the skills
necessary to be effective evaluators of student learning and how to
provide constructive feedback would enable them to be more
effective in the clinical setting.
Limitations
This research was based on self-reporting surveys therefore; a
limitation for this study is the researchers have to assume the
students responded truthfully. This study was also a convenience
sample which may limit the generalizability of the study. The
variation in teaching abilities and experiences of the clinical faculty
may also influence student self-efficacy and was not included in
this study. Student expectation of what they should learn in clinical
may also vary as well as the exposure to those learning expecta-
tions. These met or unmet expectations could influence student
self-efficacy as well and was not addressed in this research.
Implications for future research
Although, this research sheds light on to the role the nurse
educator has on student self-efficacy there is a need for further
study. Possible areas of focus would a comparison of part time
faculty to fulltime faculty and a longitudinal study, as this study
provided only a glimpse at one time of a students' clinical experi-
ences. Replication of this study at additional sites would also
confirm and increase the generalizability of the results.
Acknowledgments
Acknowledge funding for undergraduate student research as-
sistant was received from Southern Illinois University Edwardsville.
565
Partial eta squared Estimated marginal means SD
.03
5.50 1.68
6.04 1.37
.03
5.34 1.86
5.96 1.60
.03
5.56 1.67
6.10 1.41
.03
5.69 1.66
6.22 1.37
References
Bambini, D., Washburn, J., Perkins, R., 2009. Outcomes of clinical simulation for
novice nursing students: communication, confidence, clinical judgment. Nurs.
Educ. Perspect. 30 (2), 79e82.
Bandura, A., 1994. Self-Efficacy. John Wiley & Sons, Inc.
Burke, H., Mancuso, L., 2012. Social cognitive theory, metacognition, and simulation
learning in nursing education. J. Nurs. Educ. 51 (10), 543e548.
Cardoza, M.P., Hood, P.A., 2012. Comparative study of baccalaureate nursing student
self-efficacy before and after simulation. Comput. Inf. Nurs. 30 (3), 142e147.
Cook, L.J., 2005. Inviting teaching behaviors of clinical faculty and nursing students'
anxiety. J. Nurs. Educ. 44 (4), 156e161.
Elcigil, A., Yildirium, H., 2008. Students' opinions about and expectations of effec-
tive nursing clinical mentors. J. Nurs. Educ. 47 (3), 118e123.
Elliott, M., 2002. The clinical environment: a source of stress for undergraduate
nurses. Aust. J. Adv. Nurs. 20 (1), 34.
Gignac-Caille, A.M., Oermann, M.H., 2001. Student and faculty perceptions of
effective clinical instructors in ADN programs. J. Nurs. Educ. 40 (8), 347e353.
Kelly, C., 2007. Student's perceptions of effective clinical teaching revisited. Nurse
Educ. Today 27 (8), 885e892.
Knox, J.E., Mogan, J., 1985. Important clinical teacher behaviours as perceived by
university nursing faculty, students and graduates. J. Adv. Nurs. 10 (1),
25e30.
Kotzabassaki, S., Panou, M., Dimou, F., Karabagli, A., Koutsopoulou, B., Ikonomou, U.,
1997. Nursing students' and faculty's perceptions of the characteristics of ‘best’
and ‘worst’ clinical teachers: a replication study. J. Adv. Nurs. 26, 817e824.
Kuiper, R., Pesut, D., Kautz, D., 2009. Promoting the self-regulation of clinical
reasoning skills in nursing students. Open Nurs. J. 3, 76.
Lauder, W., Watson, R., Topping, K., Holland, K., Johnson, M., Porter, M.,
Roxburgh, M., Behr, A., 2008. An evaluation of fitness for practice curricula: self-
efficacy, support and self-reported competence in preregistration student
nurses and midwives. J. Clin. Nurs. 17 (14), 1858e1867.
Lee, C.J., 2007. Academic help seeking: theory and strategies for nursing faculty.
J. Nurs. Educ. 47 (10), 468e475.
Lee, W.S.C., Cholowski, K., Williams, A.K., 2002. Nursing students' and clinical ed-
ucators' perceptions of characteristics of effective clinical educators in an
Australian university school of nursing. J. Adv. Nurs. 39 (5), 412e420.
Leigh, G.T., 2008. High-fidelity patient simulation and nursing students' self-
efficacy: a review of the literature. Int. J. Nurs. Educ. Scholarsh. 5 (1), 1e17.
Livsery, K.R., 2009. Clinical faculty influences on student caring self-efficacy. Int. J.
Hum. Caring 13 (2), 53e59.
Melincavage, S.M., 2011. Student nurses' experiences of anxiety in the clinical
setting. Nurse Educ. Today 31 (8), 785e789.
Mogan, J., Knox, J.E., 1987. Characteristics of ‘best’ and ‘worst’ clinical teachers as
perceived by university nursing faculty and students. J. Adv. Nurs. 12 (3),
331e337.
Nahas, V.L., Nour, V., Al-Nobani, M., 1999. Jordanian undergraduate nursing stu-
dents' perceptions of effective clinical teachers. Nurse Educ. Today 19, 639e648.
Nehring, V., 1990. Nursing clinical teacher effectiveness inventory: a replication
study of the characteristics of ‘best’ and ‘worst’ clinical teachers as perceived by
nursing faculty and students. J. Adv. Nurs. 15, 934e940.
Papastavrou, E., Lambrinou, E., Tsangari, H., Saarikoski, M., Leino-Kilpi, H., 2010.
Student nurses experience of learning in the clinical environment. Nurse Educ.
Pract. 10 (3), 176e182.
Parsh, B., 2010. Characteristics of effective simulated clinical experience instructors:
interviews with undergraduate nursing students. J. Nurs. Educ. 49 (10),
569e572.
Pike, T., O'Donnell, V., 2010. The impact of clinical simulation on learner self-efficacy
in pre-registration nursing education. Nurse Educ. Today 30 (5), 405e410.
Polit, D.F., Beck, C.T., 2008. Nursing Research: Generating and Assessing Evidence
for Nursing Practice. Lippincott Williams & Wilkins.
Rowbotham, M., Schmitz, G.S., 2013. Development and validation of a student self-
efficacy scale. J. Nurs. Care 2 (126), 1e6, 2167-1168.
566 M. Rowbotham, R.M. Owen / Nurse Education in Practice 15 (2015) 561e566

Sharif, F., Masoumi, S., 2005. A qualitative study of nursing student experiences of
clinical practice. BMC Nurs. 4 (1), 6.
Shinnick, M.A., Woo, M., Horwich, T.B., Steadman, R., 2011. Debriefing: the most
important component in simulation? Clin. Simul. Nurs. 7 (3), e105ee111.
Sinclair, B., Ferguson, K., 2009. Integrating simulated teaching/learning strategies in
undergraduate nursing education. Int. J. Nurs. Educ. Scholarsh. 6 (1).
Tang, F.-I., Chou, S.-M., Chiang, H.-H., 2005. Students' perceptions of effective and
ineffective clinical instructors. J. Nurs. Educ. 44 (4), 187e191.
Thomas, C., Mackey, E., 2012. Influence of a clinical simulation elective on bacca-
laureate nursing student clinical confidence. J. Nurs. Educ. 51 (4), 236e239.
Viverais-Dresler, G., Kutschke, M., 2000. RN students' ratings and opinions related
to the importance of certain clinical teacher behaviors. J. contin. Educ. Nurs. 32
(6), 274e282.
Wills, M.E., 1997. Link teachers' behaviours: student nurses' perceptions. Nurs. Educ.
Today 17, 232e246.
Zulkosky, K., 2009. Self-efficacy: a concept analysis. Nurs. Forum 44 (2), 93e102.